Provider Demographics
NPI:1437208675
Name:THAXTER, NORMAN KEYES (DDS)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:KEYES
Last Name:THAXTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 COLLINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3161
Mailing Address - Country:US
Mailing Address - Phone:209-723-4268
Mailing Address - Fax:
Practice Address - Street 1:3180 COLLINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3161
Practice Address - Country:US
Practice Address - Phone:209-723-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist